Medicine: Weeding Out the Incompetents

. After repeated complaints by colleagues about his incompetence, Dr. Jacinto Lopez was stripped of his privileges at Artesia General Hospital in New Mexico. That hardly put an end to his operations. Three years later, in his own meagerly equipped and unsanitary office, Lopez undertook a lower-leg amputation with the help of an untrained assistant. Though the operation was reported, it took the state board of medical examiners six months to investigate and nearly three years to revoke Lopez's license. Meanwhile, Lopez took a standard route out of trouble: he packed his scalpel and moved to another state.

Cardiologist Felix Balasco was the pacemaker king of Rhode Island. In the 1970s he implanted more of the devices than any other doctor in the state--a practice that helped him rake in more than $100,000 a year from Medicare patients alone. Balasco's penchant for pacemakers was well known to colleagues, his hospital and insurers. A peer review five years ago confirmed that dozens of his implants were unnecessary and had put patients in needless danger. But not until this year, when he was convicted for taking kickbacks from pacemaker manufacturers, did the medical board attempt to slow Balasco's pace.

Dr. Roger Mamay looked great on paper. Over the years, he had worked in hospitals in four states, always arriving with sterling references from past associates. Thus Mamay's colleagues were astounded last August when he was convicted in Massachusetts for raping one patient and assaulting three others. An investigation by the Boston Globe showed that Mamay had come under question many times for unprofessional behavior and for sexually assaulting patients. He had been tried (and acquitted) for molesting a 15-year-old as far back as 1978. Apparently, none of this had been reported to licensing officials, and somehow, nothing appeared on his record.

What is perhaps most shocking about the cases of Lopez, Balasco and Mamay is that their transgressions were ignored or smoothed over by fellow doctors, including those who are directly responsible for policing the profession. Looking the other way is an unfortunate but time-honored tradition within the medical fraternity. Says Dr. Richard Kusserow, Inspector General for the U.S. Department of Health and Human Services (HHS): "We have long had a mystical society of physicians; they protect each other's incompetency from the public."

In recent years a number of studies and widely publicized malpractice suits ( have spotlighted the problem of medical incompetence and, particularly, the lack of disciplinary surveillance. The court-martial of Naval Surgeon Donal Billig earlier this year for involuntary manslaughter was a notorious case in point. Despite a record of having been fired by hospitals in two states, being legally blind in one eye and demonstrating skills that were described by a colleague as those of "a first-year resident," Billig had risen to be chief cardiac surgeon at Bethesda Naval Hospital, one of the nation's premier military medical centers.